I was about ready to stomp out to the nurses’ station and demand a woman interpreter. How could they do this? I was furious!
Midwife: “You will need to stay flat for two hours now. Do you need to go to the bathroom first?”
Interpreter: “Bạn sẽ cần phải ở lại căn hộ cho 2 giờ sau đó. Bạn cần phải đi vào nhà vệ sinh trước không?”
Why should you come to a foreign country and have to put up with this? I thought. I would feel so humiliated!
Midwife: “Can you put your fists under your bottom so I can reach your cervix a little better?”
Interpreter: “Bạn có thể đặt nắm tay của bạn dưới mông của bạn để tôi có thể tiếp cận cổ tử cung của bạn tốt hơn một chút được không?”
It was awful! He acted as if he does this every day. He does do it every day. It’s his job. She must have been feeling so embarrassed.
The last time I had to throw someone out during a birth was when I worked at a free-standing birthing clinic and found both sides of the family of the couple in the kitchen smoking up a storm and setting up a bar. They were going to party until their baby was born. I tried to nicely explain that we weren’t set up like a hospital exactly, we didn’t have a waiting room, and we would need the run of the whole floor so she could walk around during labor (not to mention any other clients who might show up that night to fill the remaining two birthing suites). I suggested a motel down the road—some of them had driven from more than an hour away—so they reluctantly packed up and camped out in our parking lot for a while, serving drinks from the car’s trunk until it started raining around midnight. We assured them we would have the couple call them when the baby arrived. BYOB to a birth? Really?
Midwife: “Just breathe slowly. You will feel my touch now . . . ”
Interprer: “Hãy thở chậm lại. Bây giờ bạn sẽ cảm thấy tay tôi . . .”
How humiliating! “You will feel my touch now . . .” said the smooth, deep voice coming from behind a flimsy curtain.
Midwife: “Just breathe slowly. Great. Thank you.”
Interpreter: “Thở chậm lại. Tuyệt vời. Cảm ơn bạn.”
Midwife: “I hope you can get some sleep now.”
Interpreter: “Tôi hy vọng bạn có thể ngủ một lúc bây giờ.”
Midwife: “I’ll check back in the morning.”
Interpreter: “Tôi sẽ kiểm tra lại vào buổi sáng.”
One Friday night I brought my baby doll Tofiq when I met with Khou. We had been meeting for the past three months discussing her birth plan, seeing videos together on birth and the stages of labor, and breastfeeding, and going to classes about interventions and options. She asked if I had a camera and begged me to bring it to her birth. I promised I would.
Khou, though barely eighteen, had asked at our last appointment who was going to teach her how to bathe her baby when s/he was born, so I arranged for a translator and we all crammed into her tiny bathroom that evening: Khou; the interpreter; the shelter director, a young social worker who had never bathed a baby before, either, and had asked to come; and Tofiq and I. So I filled the tub, lined up the soap, shampoo, towel, and washcloth, and gave Tofiq a real bath, showing Khou how to first test the temperature of the water by dipping in an elbow and then how to support him in the water (he is even anatomically correct, which sent her into giggles). Then I had her do it all over again by herself. She did a great job until she laid him on the towel on the floor. I suggested at that point that her baby looked pretty cold to me. She quickly dried him off and wrapped him up in the towel and held him close, looking up at me for approval. I said he looked better but, “Look, his mouth is open and he is probably hungry.”
A look of panic spread across her face. I didn’t need the interpreter to repeat what she said then: “Oh, no!” as in, “What do I do now?” So we had a mini class there on the bathroom floor about how to get him in the best position for nursing: “Belly to belly, chest to chest . . . nose and chin should touch the breast.”
She reminded me for the umpteenth time to be sure to bring a camera to the birth. I promised again that I would.
Midwife: “Well, you have dilated to five centimeters! That’s great news!”
Interpreter, as he clipped his nails: “Ồ, bạn đã giãn ra đến 5 cm! Thật tuyệt!”
I rummaged through the cupboards in the room until I found a dilation chart. I got the interpreter to explain what dilation is and what “five” looked like. Finally, I said, “You can go now.” I pointed to the door and thanked him. At last he was gone. It wasn’t his fault. But couldn’t he protest? She could have been his daughter, for heaven’s sake!
Doulas sometimes need reminding to breathe slowly, too. I would explain myself in pantomime from now on if I had to and show Khou how she would open up the rest of the way until she could push her baby out.
The nurse wheeled in some kind of a reclining lounge chair and to my utter surprise made it up with clean sheets and pillows for me. Khou and I finished the last of the snacks I had brought and I went down to the nutrition room and got us hot drinks. Most hospitals will even give doulas the door combinations to the kitchen or linen closet so we can help ourselves and take care of our moms without having to get a nurse every time. Warm blankets? No problem. Just dial 1-5-3-2 on the door’s lock pad.
The rushes continued for another two hours but eventually settled down and Khou was sound asleep by about 3:00 a.m. I slept too and didn’t hear anything until she called my name at 8:00 a.m. In her limited English she sheepishly said, “Stephy-ah, me hungry.” I stretched, got out of my little bed and fumbled around the bedside stand until I found the folder with the menu options and the extension to call to order meals. She knew the words for “bread,” “eggs,” “tea,” and “meat,” so I ordered it. While we waited for her breakfast, she again asked if I had the camera ready. I pointed to it sitting on the counter.
When the food tray arrived she dove into it. They had included a blueberry muffin, which instantly became her favorite American food. She tried to order just blueberry muffins for lunch but we were told they were only a breakfast option. Later that day I let the secretary at the ward’s front desk know so she could make sure Khou got two blueberry muffins on her tray every morning while she was in the hospital.
Soon after she finished eating, the rushes started again in full force (it is amazing what a little food and sleep will do) and breakfast suddenly made a surprise appearance once again. I told her not to worry about it and helped her clean up and rinse her mouth. I told her what Ina May Gaskin says about this: that you actually dilate one centimeter every time you vomit during labor. It works this way because a person can’t totally relax their throat and mouth without also relaxing the sphincter muscles down below.
Before long Khou’s labor was picking up speed beautifully. We stood, we walked, she sat on the birth ball. She asked for pain medicine at one point and asked about an epidural (and in the same breath asked if I still had the camera handy). The midwife said that she could get an epidural if she wanted it, but that she had other options too, and suggested some fentanyl, which would take the edge off the pain but still allow her to be up and moving around. She explained that it worked for an hour or two at the most. Khou said she wanted something and agreed to try it. She was very happy with the results and was able to rest. She asked again if I had the camera ready and I assured her I did as I pointed to it on the bedside stand. She closed her eyes and was able to manage the rushes better.
She asked the midwife the next time she was in the room if Mary, the midwife she had been seeing in clinic, was going to be at her birth. She was assured that Mary had been called. Khou again closed her eyes. We breathed through each rush and then rested. We were in a pattern now: “Breathe . . . slowly . . . blow it away . . . rest. Breathe . . . slowly .
. . blow it away . . . good work!”
Suddenly Khou’s eyes opened wide and she said, “I go toilet now!” I knew this was the urge to push without even knowing if she was at ten centimeters. The midwife with us did, too, and didn’t even check her cervix. Then Khou asked, “Where is Mary? I want Mary!” just as Mary walked in.
She checked Khou and said, “Well, she’s complete. Can we get the room ready?” The nurses spun into action. The warmer was turned on. They checked the equipment, unfolded baby blankets and stacked up towels as Mary robed up and I tied the strings on the back of her gown.
We helped Khou lean forward from her sitting position and put a squatting bar in place while I stacked pillows behind her with one hand, the camera ready in my other hand. The nurse lowered the end of the bed slightly before the next rush. Khou flashed Mary a panicked glance, which we recognized as the classic “Tell me what I am supposed to do next” look. Mary smiled and told Khou that she was doing just great. She waited for the next rush and, nodding her head, said quietly, “You can push a little now.” It took a few more rushes for Khou to get the hang of it but very quickly the little head was crowning. Then Baby literally dropped out onto the end of the bed during the next push, completely surprising Khou. If looks could talk, hers would have said, “Where did that baby come from?” I did get pictures, lots of them.
I voiced my complaint about the male interpreter as civilly as I could manage as I passed the nurses’ desk on my next trip for coffee and was able to get a woman interpreter for my postpartum visit the following day. As I waited at my bus stop earlier that morning in front of a florist shop, it occurred to me that no one would be bringing Khou flowers after all her hard work. I wished I had the money for a huge bouquet but I didn’t just then.
As I walked into Khou’s room, a young nurse was arranging a beautiful little arrangement of pink tea roses on Khou’s bedside table. It was the nurse’s birthday and someone (special, I could imagine) had sent flowers but she said she wanted Khou to have them. I had never seen an act of kindness such as that in a hospital before.
I asked Khou if anyone had explained how or what they had done to fix the tear after her birth. She shook her head. Her midwife had simply explained that she was going to repair a tear, though I doubt any of it registered with Khou then. I knew she had been quite mystified by everything and could not take in one more thing, so I postponed that discussion.
When we did talk about it I drew a picture of her anatomy at the time of birth, explaining how the baby’s head had stretched her vagina as he crowned. Then I drew a picture of what it looked like after birth, with the tear along the vagina’s back wall. I explained that Mary had used a small round needle to first pull together the underlying muscle, pushing everything back into place there, and then closed the tear with small stitches along both edges of the torn skin. I told her that the string was a self-dissolving material so the stitches wouldn’t need to be removed later. Then I told her that her midwife was a real artist and she looked absolutely beautiful down there. She questioned the interpreter, wondering if she had heard that last comment right and I assured her that she had, and that I had seen lots of women so I should know.
At this point another nurse came into the room to do a blood pressure check and stopped to look at the diagrams. She glanced at Khou and then back at me, looking very puzzled. I told her that no one had explained to Khou what had happened or why, so I was taking the time to show her what had gone on “down there.” I added, “I think she should know what happened and understand what was done to her own body.” This seemed to be a completely foreign concept to this particular nurse.
Epilogue
Khou had been married before moving to the U.S. She arrived pregnant, with her husband and his parents. The home situation deteriorated quickly as culture shock set in and the men in the family could not find work and had to attend English classes, both of which they found profoundly humiliating. Apparently, from the little I know, Khou’s husband took out his frustrations on her, which landed him in jail. She was placed in the shelter by the courts. When her baby was three months old she relocated with him to another state and with the help of an aunt there has been able to return to school and was recently accepted into a college.
[Heartfelt thanks to Mr. Vu Nguyen of the University of Minnesota, for his excellent translations for this story.]
Doula as gatekeeper.
“Putting women in the position of coping with conflict when they should be concentrating on having their babies counts as an intervention in itself!”
~Anonymous
Chapter 20: A Doula for a Doula
When Jessica came to Everyday Miracles for our first meeting, I gave her a tour of the offices and visited with her. She was quite excited about her baby and she and her husband had both already read a lot of information about natural birth and knew what they wanted. She gave me a copy of her birth plan, which looked perfect. I didn’t add a thing. Then she told me she was in training to be a doula. Oh, wow, I thought. This will be fun!
She had taken the DONA birth doula course already and sent for the certification package. At that point she had two years to meet all the requirements and submit her paperwork. She had attended a few births already and was gathering the rest of the information she would need. I invited Jessica to meet at my apartment for her next appointment and offered to lend her any books that I had used when I was being certified. Thus began our friendship.
Since I didn’t need to educate her about labor or breastfeeding we used the times we got together to look at birth videos. I had several other teaching videos that Jessica had not seen, so we watched those together and talked about everything about birth and doulas and midwives and hospitals.
It was just after 5:00 a.m. several weeks later when Jessica’s husband, Jim, called to let me know she was in labor with regular rushes. I asked if I could speak to Jessica (which would give me a clue if this was early labor or the real thing by how well she could talk to me during a rush). I encouraged her to labor at home a while longer if she was comfortable there. I called back about an hour later not having heard again, and spoke to Jim because Jessica could no longer speak through the rushes. I asked if they were thinking of heading to the hospital soon and he said they were still thinking about it. I offered to come to their house but they felt they were doing okay on their own. When I called back another hour later I asked if they wanted to have this baby at home or in the hospital and that got them out the door in no time.
I was very excited for Jessica and had been looking forward to this birth. She was so down-to-earth, so well prepared, and so healthy, I knew it would be a great experience. I quickly dressed, checked my doula bag, and called a taxi. I was at the hospital within fifteen minutes. I asked at the desk if Jessica had shown up yet and they assured me they had not come in. A half-hour later, I checked at the desk again and they said she had still not arrived. They asked again what her last name was, and they couldn’t find her in their system. I called Jim and quickly realized I was at the wrong hospital!
I had never done that before. I hadn’t opened her chart; I just assumed I knew which hospital they were going to. Apologizing profusely, I hung up and again called the cab company. I couldn’t believe it. Was I getting senile? After this birth I put a pad of paper and a pen next to my alarm clock and I ask every single time what hospital we are meeting at, even if I think I know, and write it down . . . each time.
I arrived at the right hospital twenty-five minutes later, wearing my “Happy Birthday” tiara. Jessica was still in the triage area of labor and delivery. There were no free rooms in the regular section. It was early, but there was really no room to move around at all. We couldn’t walk around the halls because family members of all of the emergency room patients were milling around. After monitoring the baby for a while the nurse said she would let us know when something opened up on the floor.<
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In Jessica’s own words: “We were finally moved to a labor and delivery room, though not in the midwife section, and they brought in a portable tub right away but had issues filling it, so y’all were grabbing buckets of water from the sinks to fill it. I had to pee but just couldn’t and spent some time on the toilet whilst the tub was being filled . . . oh, and the popsicles, those were life-savers!
“Once filled, I labored in the tub until I got too warm, then stood in the tub and swayed and slow danced with Jim while you and my friend rubbed my back and fed me popsicles and water. Things were moving rather quickly. I came in at six and my waters broke—a water balloon between my legs—and a couple of hours later I was eight centimeters. Then things slowed down and I labored on all fours in bed while y’all reminded me to breathe and gave me my elixirs—water and popsicles. Once I felt the urge to push the midwife checked my cervix and I still had a lip on one side, which I later learned is a sign of the malposition of a baby’s head. I waited until I could push.”
Her midwife assured her that the baby sounded very good when she listened using a Doppler. Jessica explains, “Once pushing, I didn’t feel like any progress was being made and asked if this was really possible.” It was hard to tell her she was doing everything right when she knew her baby wasn’t moving down much.
“They made me change positions a few times, not delightful in high-pushing mode, and I finally ended on my back with my legs in the air, pulling on the sheet attached to the squatting bar. [Finally we could see a tiny circle of baby’s head.] Then the little guy came out after two-plus hours of pushing. Bring on the waffles! This mama’s hungry!”
Jessica pushed for what seemed like forever and finally her baby boy was born, all nine pounds, six ounces of him. And as he came out, out of the corner of my eye I saw a geyser of blood shoot straight up in the air. The midwife was at the bedside and saw the blood at the same time. We both reacted immediately. Somehow it registered in my mind that the cord must have broken at that moment, and in one move I spun around, grabbed a medium forceps clamp from behind us on the table and, opening it up, handed it to the midwife. She pinched the cord still at baby’s end with one hand and, taking the forceps, grabbed the placenta end of the cord as it disappeared back up into the birth canal.
Ma Doula Page 14